How to find insurance member id

Updated April 30, 2018 -- For Administrators and Employees

If you've lost or haven't received your insurance cards, you can contact your insurance carrier to find your Member ID. Due to restrictions around Protected Health Information (PHI), Zenefits cannot store your Member ID number in our system. You can find your insurance plan name and Group number in Zenefits and find your insurance carrier's Member Services contact information under the Medical Insurance application beneath the Member Services & Claims Info link.

For Dental and Vision insurance, you can simply use your SSN as your Member ID.

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You may not think about your health insurance ID card very often. After all, it probably spends most of its time in your wallet—until you, your doctor, or another medical provider really need it.

Let’s take a minute, though, to look at the many important pieces of information you can find on your card. After all, it’s your passport to care and coverage, so you should know what all of the fields of information really mean.

The descriptions below apply to most private health insurance ID cards in the United States. If you live outside the U.S. or have government-provided insurance, you may see some different fields on your card. CDPHP® is dedicated to helping you understand your health insurance, but you should always call your own insurer at the customer service number on your card if you have questions about your specific health plan or coverage.

Most health insurance cards contain straightforward identification information about the people covered and the policy you have.

Carrier and Contact Information

This is the name of your insurance company and one or more ways to reach them, like their website and phone numbers for customer service or other specific needs. Some of this information may be on the back of the card.

Names of Covered Individuals

If you are the policyholder, your name will be on the card. If you have dependents—like a spouse or children—on your health insurance policy, their names might be listed on your card, too. If you are not the policyholder, then your card may show your name and the policyholder’s name in separate fields.

Member ID/Policy Number

Each person covered by a health insurance plan has a unique ID number that allows healthcare providers and their staff to verify coverage and arrange payment for services. It’s also the number health insurers use to look up specific members and answer questions about claims and benefits. This number is always on the front of the card. If you’re the policyholder, the last two digits in your number might be 00, while others on the policy might have numbers ending in 01, 02, etc.

Group Number

Each employer that purchases a health plan for its employees also has a number. This group number identifies the specific benefits associated you your employer’s plan. Healthcare providers use the group number plus your member ID number to file claims for your care. If you purchase insurance through a healthcare exchange (the marketplaces set up by the Affordable Care Act, sometimes called “Obamacare”), you might not have a group number.

Plan Type/Plan Name

There are many different kinds of health insurance plans. Insurance companies list the type of plan on your ID card to help healthcare providers file claims properly. For some plan types, the plan type will be listed on the ID card (example: HMO), while Medicaid and Child Health Plus cards will feature each program’s respective logo. Each plan type has different ways of handling referrals, in- and out-of-network providers, and out-of-pocket costs. The most common types are:

• HMO (health maintenance organizations)
• PPO (preferred provider organizations)
• EPO insurance plans (exclusive provider organizations)
• HDHP (high deductible health plans)
• Essential Plan

Some insurance companies give specific names to certain plans, like those available through the healthcare exchange, instead of using group numbers (above).

Payment Information

Many health insurance cards show the amount you will pay (your out-of-pocket costs) for common visits to your primary care physician (PCP), specialists, urgent care, and the emergency department. This may be a flat rate (copay) or a percentage of the cost (coinsurance). If you see two numbers, the first is your cost when you see an in-network provider, and the second—usually higher—is your cost when you see an out-of-network (OON) provider. For example, when you’re referred to a specific specialist or sent to a specific hospital, they may not be in your insurer’s network.

Medical Network

Your insurance company may provide out-of-area coverage through a different health care provider network. If so, the name of that network will likely be on your insurance card. This is the network you’ll want to seek out if you need access to healthcare while you’re away on vacation, or out of town on a business trip.

Prescription Benefits

If your plan includes benefits for prescription drugs, you will also find some information related to them on your health insurance ID card.

Formulary

The formulary is the list of prescription drugs that your insurance company covers. Some insurers have different formularies that are covered under different plans—and they indicate which formulary on members’ ID cards. For example, CDPHP members will see Formulary 1, Formulary 2 or the Medicaid Formulary on their cards. (If you are a CDPHP member with no formulary listed on your card, you have Formulary 1.)

Prescription Costs

Most formularies are divided into three tiers containing different types of drugs. Each tier is set at a different price that you’ll pay when you pick up your prescription at a participating pharmacy. Usually, generic drugs make up most of Tier 1, brand name drugs cost a bit more and make up most of Tier 2, and specialty drugs (which cost the most) make up most of Tier 3.

Pharmacy Network

Different insurance plans sometimes cover different pharmacy networks. If so, this is likely to be on your insurance card. For example, CDPHP employer plans use a Premier network; CDPHP individual plans (like those through the healthcare exchange) use a Value network; and CDPHP plans for seniors use the Medicare network.

Rx BIN (banking identification number)

Your pharmacist will use this number to process your prescription. It indicates which company will reimburse the pharmacy for the cost of the prescription. Not all insurance ID cards contain this number, though.

Helpful Resources

That seems like a lot of information to pack onto a little rectangle—and it is! Still, you may find additional information on your card, such as:

• Important telephone numbers and addresses that allow your healthcare providers to call for information (such as coverage verification, claims questions, pre-authorizations, etc.)
• Hotlines to help you get specific help quickly (to report fraud, for example)
• Resources to help you find specialty care (chemical dependency services, etc.)

Remember: If you’re a CDPHP member, you can view your ID card online through our secure member site or using the My CDPHP Mobile app.

You can always call the customer service number on your card to ask any questions about the details of your plan.

When you sign up for health insurance, your health plan will send a member identification (ID) card to you and your covered family members. Your member ID card (or health plan ID card) is proof that you have health insurance. Health care providers use the information from your member ID card to confirm they are part of your plan’s network and to bill your health plan for your care. Some plans have mobile apps that let you share the member ID card on your smartphone or tablet. Keep your member ID card handy when you:

• Go to the doctor
• Go to the hospital
• Have lab work done
• Get a prescription filled (if your plan has drug coverage)

UnitedHealthcare® members with plans through an employer may download the UnitedHealthcare app to view and show their member ID card on their smartphone or tablet.

If your card is damaged, or if you find a mistake on your member ID card, call the number on your card to request a new card. If you have lost your member ID card, contact us.

Here are some examples of UnitedHealthcare member ID cards. Your member ID card may vary depending on your specific health plan and coverage.

Your member ID number and group number allow healthcare providers to verify your coverage and file claims for health care services. These numbers also help UnitedHealthcare advocates answer questions about your benefits and claims.

• Member ID number: A unique member ID number that links to your specific health insurance benefits and coverage.
• Group number: This number is unique to your company and is the same for all employees who participate in the insurance plan.
• Member/dependents: Your name (if you’re the policyholder) and other family members covered under your health plan.
• PCP: Primary Care Provider. Some plans require members to choose a primary care provider (PCP). If required, your PCP will be listed on your member ID card. A PCP is your main point of contact for most health issues or concerns. It can be a licensed physician, nurse practitioner, clinical nurse specialist or physician assistant.
• Copay: If your plan has copays, the copay for certain services may be listed on your member ID card. Your copay is the fixed amount you pay for certain covered health care services. It is usually paid when you receive the service.
• Your network: Before selecting a primary care provider (PCP), check that they are in your plan network. You can call the service number on your member ID card, or sign in to your health plan account and search the provider directory.
• Referrals required: If this appears on your card, check your benefit plan documents to see which services may require a referral (or recommendation) from your PCP for medical care beyond what your PCP can provide.
• Pharmacy benefits: If your plan includes pharmacy benefits from OptumRx®, your member ID card lists the numbers your pharmacy will need to verify your insurance coverage when filling prescriptions.

The back of your member ID card includes contact information for providers and pharmacists to submit claims. It also includes the member website and health plan phone number, where you can check benefits, view claims, find a doctor, ask questions and more.

A member ID number and group number allow healthcare providers to verify your coverage and file insurance claims for health care services. It also helps UnitedHealthcare advocates answer questions about benefits and claims.

• Member ID number: Each member has a unique member ID number linked to their specific health insurance benefits and coverage.
• Group number: This number is the same for everyone who participates in that insurance plan.
• Member: Your name
• PCP name: Primary Care Provider. Some plans require members to choose a primary care provider (PCP). If required, your PCP will be listed on your member ID card. A PCP is your main point of contact for most health problems or concerns. It can be a licensed physician, nurse practitioner, clinical nurse specialist or physician assistant.
• PCP phone number: Phone number for you to easily call your primary care provider.
• Copay: If your plan has copays, the copay for certain services may be listed on your member ID card. Your copay is the fixed amount you pay for covered health care services. It is usually paid when you receive the service.
• Pharmacy Benefits: If your plan includes prescription drug coverage, your pharmacy will need to see your member ID card to verify your insurance coverage when filling prescriptions.
• Medicare limiting charges apply: When doctors don’t accept Medicare but haven’t opted out entirely, the most they can charge is 15% over what Medicare will pay for that service (in addition to out-of-pocket costs). Limiting charges do not apply to medical equipment or supplies.

The back of the member ID card includes the member website and phone numbers to connect with customer service, speak with a nurse and discuss behavioral health. It also includes contact information for providers and pharmacists to submit insurance claims.

A member ID number and group number let healthcare providers verify your coverage and file claims for health care services. It also helps UnitedHealthcare advocates answer your questions if you call about benefits and claims.

• Member ID number: Each policy holder has a unique member ID number that links to your specific health insurance benefits and coverage. For some members, a unique State ID may also be present on the member ID card.
• Group number: This number is the same for everyone who participates in that insurance plan.
• Member: Your name
• PCP name: Primary Care Provider. This is your main point of contact for most health problems or concerns. It can be a licensed physician, nurse practitioner, clinical nurse specialist or physician assistant. Not all member ID cards contain this information.
• PCP phone number: Phone number for you to easily call your primary care provider.
• Pharmacy Benefits: When your plan includes pharmacy benefits, your pharmacy will need to verify your coverage when filling prescriptions.

The back of the member ID card may include phone numbers to connect with customer service, speak with a nurse and find behavioral health support. It also includes contact information for providers and pharmacists to submit claims.

Unfortunately, new health care fraud and abuse schemes are constantly occurring. Thankfully, they are also regularly uncovered. You can help protect yourself and your family by staying informed.

Consider these tips to help safeguard your personal information:

• Treat your member ID card as you would a credit card
• Never provide personal information, such as your member ID number, credit or debit card number (or other personal information) on a phone call you did not initiate
• Do not let anyone except your physician’s office or pharmacy handle your member ID card. If anyone else requests your personal information, do not provide it.
• Never accept “free” medical equipment or services in exchange for your member ID number
• Shred financial documents before discarding
• Monitor your financial accounts regularly